Concomitant trans-styloid and trans-scaphoid perilunate fracture-dislocations: evaluation of surgical outcomes in the largest reported series

Background: Concomitant trans-styloid and trans-scaphoid perilunate fracture-dislocations (PLFDs) are rare, complex wrist injuries caused by high-energy trauma. This study evaluates the surgical outcomes of a cohort of 28 patients treated with open reduction and internal fixation (ORIF) combined with ligament repair. Methods: A case series study was conducted on 28 adult patients with acute trans-styloid and trans-scaphoid PLFDs who underwent surgical treatment between 2013 and 2024. Surgical procedures included ORIF using K-wires or Herbert screws, ligament repair, and carpal tunnel decompression when indicated. Outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, range of motion, and complications. Results: The study included 17 male patients with a mean age of 29.71 years who were followed for more than 1 year. Falls from height were the most common mechanism of fracture (58.82%), with 35.29% experiencing nerve injuries. Functional outcomes showed favorable results, with low pain levels [visual analog scale (VAS): 0.76] and minimal disability (DASH: 3.45). The VAS pain scores for the nerve injury group were 1.75 (SD: 1.16), compared to 1.40 (SD: 1.31) in the no nerve injury group, and DASH scores were 9.55 (SD: 7.54) for the nerve injury group versus 5.39 (SD: 5.76) for the no nerve injury group. Conclusion: This study presents the largest series to date evaluating concomitant trans-styloid and trans-scaphoid PLFDs. Surgical treatment using open reduction, internal fixation, and selective ligament repair led to favorable functional outcomes. Early diagnosis and timely surgical intervention are essential to minimizing complications.